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We must create healthy workplaces across the health care sector

Recently, Access Alliance, a community health centre in Toronto, posed an interesting challenge to fellow health care, education, child care and social service organizations: get rid of precarious jobs in the public sector.

It makes sense. An important part of the public sector’s role is to build a healthy society. Precarious jobs – temporary, part-time, low paying or without benefits – hurt people. They impact wellbeing, and contribute directly to poor health. A recent report from McMaster University and the United Way demonstrates that precarious employment is associated with anxiety and unstable social structures. Access Alliance has compiled evidence of the further health impacts of precarious work, including an association with higher rates of diabetes, heart attacks and fatal occupational injuries.

Unfortunately, precarious work has been increasing in Ontario, as documented by several studies. The McMaster and United Way report surveyed over 4,000 adults in the Greater Toronto and Hamilton area and found that at least one in five had experienced precarious employment. More generally, they found that more and more people are working in precarious jobs.

This comes as no surprise to front-line health care workers, who see first-hand the negative impacts of stress, uncertain schedules, lack of sleep, limited or irregular income, unaffordable and poor quality housing, lack of access to good nutrition and lack of coverage for prescription drugs, dental and vision care.

What might be surprising, however, is the fact that the health sector itself is contributing to the problem. Precarious work is experienced by home care workers and personal support workers (and can have a deeply negative impact on their patients); housekeeping and other staff when services are contracted-out; and many who work in Ontario’s non-profit service sector. Precarious jobs in the health care sector take many forms: casual ‘community animator’ positions, hospitality jobs that do not pay a living wage, short-term contracts that do not come with paid sick days or other extended benefits, internationally trained professionals who donate their work as volunteers, and many other examples.

We have experienced the pressures that result in organizations offering precarious employment. We have heard the rationales – in some cases, we have repeated them to ourselves when we have used grant money to put together contracts of our own. For example, grants often cover only short-term project funding, making it difficult or impossible to employ people in permanent jobs. In addition, part-time, casual and volunteer positions are often positioned as important ‘capacity building’ and networking exercises or ‘better than nothing’ for students, internationally trained professionals, and people who are simply out of work. Finally, austerity measures implemented by government have rippled through the public sector in Ontario. Many health and social service organizations are under enormous pressure to contain or reduce costs, which can come at the expense of permanent jobs and the health of workers.

There are many ways for decision-makers, practitioners and researchers within health care to promote secure, healthy employment. Health care researchers can develop new indices of ‘healthy jobs’ and promote the use of such measures by funding agencies to ensure funds are used to support good jobs in both health research and health care. Furthermore, accreditation processes for health and social service organizations should measure the degree to which organizations are supporting healthy jobs.

Access Alliance suggests several further measures that organizations can take. These include:

Limiting temporary, part-time jobs to less than 5% of an organization’s workforce (as recommended by the International Labour Organization).

Making sure temporary, part-time employees are offered fair wages, extended health benefits, and generous professional development opportunities to help find stable employment.

Other organizations and campaigns suggest additional innovative measures and approaches. As just one example, students and workers at Harvard spent several years working to see the university implement a living wage for all associated workers, with some success.

It is important to note that systemic racism and institutionalized discrimination in both the labour market and the broader society means that precarious work is disproportionately experienced by some groups, including people who are racialized, women, immigrants, and/or living with disabilities. Minimizing precarious and insecure employment and making sure good, permanent jobs are equitably distributed within an organization should be part of every organization’s equity strategy. Regular equity assessments can provide the institutional data and strategies for health care agencies to achieve this goal.

As health care providers and researchers, we write and speak frequently about the links between equity and health. Our gaze is often focused externally, on issues that make people sick or compromise their access to care. More difficult, perhaps, is to look at our own practices and sector. But these are the places we might be able to make substantial change, and the health care sector should, logically, lead the charge in creating healthy work places, starting with secure, good paying jobs.

Amy Katz is a knowledge translation specialist at the Centre for Research on Inner City Health (CRICH) at St. Michael’s Hospital. Follow CRICH on twitter @crich_stmikes. Ahmed Bayoumi is an Internal Medicine physician at St. Michael’s Hospital. Follow Ahmed on twitter at @AMBayoumi. Azad Mashari is a physician in the Department of Anesthesia and Pain Management at the University Health Network and Mount Sinai Hospitals. Andrew Pinto is a family doctor at St. Michael’s Hospital. Follow Andrew on Twitter at @AndrewDPinto.

Enter the debate: reply to an existing comment

4 comments

Karen BornMarch 26th, 2015 at 10:16 am

Thank you Amy and your co-authors for this important piece. Your comments about our own practices in research and health care in offering short term, or unpaid ‘internship’ opportunities particularly resonated.

The implications of these unpaid internships go far beyond the short term and can influence someones chances of getting into graduate and professional education programs. Undergraduate or highschool students who need to earn money during time off from studies will not have the same list of impressive accomplishments or international volunteer experiences on their CVs as those who can afford to do unpaid internships and ‘voluntourism’.

This is a well known and researched issue in medicine in particular, with admissions criteria favouring students from high income backgrounds.

I totally agree with your final point that as health care providers and researchers, we should be leading by example and ensuring that students are appropriately compensated for their work.

Thank you for your comment Karen! That’s an important point, and thank you for raising it. I guess the next question is how we, from our various positions in health care research and provision, can move this forward. It would be great to see living wage policies and paid sick days for all workers implemented at all Ontario health and social service organizations as one step. Including for services that are sometimes contracted out – like cleaning – and for work done by students. Would be great to share ideas about next steps!

Great article, but I’d like to add that part time positions are not necessarily a bad thing. Many mothers, or fathers in some cases, who need to take care of their young children need part time work. If all available positions are full time, they can’t even work at all due to such things as child care costs. For those with young children or with other family responsibility, it is hard to work full time unless they delegate their home responsibility to other poorly paid domestic workers who are even more vulnerable to inequity. I’d say that it is important not to paint part time positions as inherently bad.

I would echo some of the earlier sentiments that have been stated by Karen and Amy. I would also say that the standard for labour practices in the healthcare sector set the tone for other sectors (i.e. if he hold ourselves to a high standard, then other sectors have less of an excuse to be exploitive but if the “helping” professions have bad labour practices, it’s hard to convince other folks to do better)

This document is provided under the terms of a CreativeCommons Attribution Non-commercial Share Alike license. The terms of the license are available at: http://creativecommons.org/licenses/by-nc-sa/3.0/. Attributions are to be made to HealthyDebate.ca, a project under the direction of Dr. Andreas Laupacis, at the Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital.